Healthcare Provider Details

I. General information

NPI: 1063613420
Provider Name (Legal Business Name): ANDREW SCOTT RODGERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 EAST UNIVERSITY PARKWAY UNION MEMORIAL HOSPITAL DEPT OF RADIOLOGY
BALTIMORE MD
21218
US

IV. Provider business mailing address

2401 W BELVEDERE AVE
BALTIMORE MD
21215-5216
US

V. Phone/Fax

Practice location:
  • Phone: 410-554-6660
  • Fax:
Mailing address:
  • Phone: 410-601-5054
  • Fax: 410-601-8131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberD0065412
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License NumberD00635412
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD65412
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25IA12804000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: